Exelon Patch Dosage/Direction for Use

Dosage: See Table 6. (See Table 6.)

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Mild to Moderate Severe Dementia of Alzheimer's Type and Associated with Parkinson's Disease: Initial and Titration Dose to the Effective Dose: Treatment is started with Exelon Patch 5 once a day.
After a minimum of 4 weeks of treatment and if well-tolerated, this dose should be increased to Exelon Patch 10, the recommended effective dose which can be continued for as long as therapeutic benefit for the patient exists.
Individual responses to rivastigmine may vary and some patients may derive additional benefit from higher doses. Subsequent increases to Exelon Patch 15 and then to Exelon Patch 20 should always be based on good tolerability of the current dose and may be considered only after a minimum of 4 weeks of treatment at each dose level.
Severe Dementia of the Alzheimer's Type: Initial and Titration Dose to the Effective Dose: Treatment is started with Exelon Patch 5 once a day. Subsequently the dose should be increased to Exelon Patch 10 and then to Exelon Patch 15 which is the demonstrated effective dose. These dose increases should always be based on good tolerability of the current dose and may be considered only after a minimum of 4 weeks of treatment at each dose level.
Interruption of Treatment: Treatment should be temporarily interrupted if gastrointestinal adverse effects and/or worsening of existing extrapyramidal symptoms (eg, tremor) are observed until these adverse effects resolve. Patch treatment can be resumed at the same dose if treatment is not interrupted for >3 days. Otherwise treatment should be re-initiated with Exelon Patch 5.
If adverse effects persist on re-initiation of therapy, the dose should be temporarily reduced to the previous well-tolerated dose.
Switching from Capsules or Oral Solution: Patients treated with Exelon capsules or oral solution may be switched to Exelon patches as follows: A patient who is on a dose of oral rivastigmine <6 mg/day can be switched to Exelon Patch 5; a patient who is on a dose of oral rivastigmine 6-12 mg/day may be directly switched to Exelon Patch 10.
It is recommended to apply the 1st patch on the day following the last oral dose.
Renal Impairment: No dose adjustment is necessary for patients with renal impairment (see Pharmacology: Pharmacokinetics under Actions).
Administration: Exelon transdermal patches should be applied once a day to clean, dry, hairless, intact healthy skin on the upper or lower back, upper arm or chest, in a place which will not be rubbed by tight clothing.
The patch should be replaced by a new one after 24 hrs.
For Patients and Caregivers: The previous day's patch must be removed before applying a new one. The patch should be replaced by a new one after 24 hrs. Only 1 patch should be worn at a time (see Precautions and Overdosage).
The patch should not be applied to skin that is red, irritated or cut. It is recommended to change the application site daily to avoid potential irritation, although consecutive patches can be applied to the same general anatomic site (eg, another spot on the upper back).
The patch should be pressed down firmly for at least 30 sec using the palm of the hand until the edges stick well.
If the patch falls off, a new one should be applied for the rest of the day, then it should be replaced at the same time as usual the next day.
The patch can be used in everyday situations, including bathing and during hot weather. The patch should not be exposed to any external heat sources (eg, excessive sunlight, saunas, solarium) for long periods of time.
The patch should not be cut into pieces.